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12 - Hypothermic neural rescue for neonatal encephalopathy in mid- and low-resource settings

from Section 2 - Clinical neural rescue

Published online by Cambridge University Press:  05 March 2013

By
Nicola J. Robertson  and
Sudhin Thayyil
Edited by
A. David Edwards ,
Denis V. Azzopardi  and
Alistair J. Gunn
A. David Edwards
Affiliation:
Institute of Reproductive and Developmental Biology, Imperial College, London
Denis V. Azzopardi
Affiliation:
Institute of Reproductive and Developmental Biology, Imperial College, London
Alistair J. Gunn
Affiliation:
School of Medical Sciences, University of Auckland
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Summary

Introduction

The most significant burden of neonatal encephalopathy (NE) occurs in low- and mid-resource settings [1]. The WHO World Health Report 2005 estimated that an annual 1 million survivors of “birth asphyxia” may develop cerebral palsy, learning difficulties or other disabilities [2]. Globally, perinatal asphyxia is responsible for 42 million disability life adjusted years – this is double that due to diabetes and three quarters of that due to HIV/AIDS [1]. Almost one quarter of the world’s 4 million annual neonatal deaths are caused by perinatal asphyxia (Figures 12.1, 12.2) [3]: 99% of these deaths occur in low- and mid-resource settings especially those countries with higher neonatal mortality rates (Figures 12.1, 12.2). The potential benefits of therapeutic hypothermia (were it to be safe and effective in every setting) are potentially greater in low- and mid-resource settings where birth asphyxia is at least 10-fold higher than in the developed world. However, all the positive evidence about the safety and efficacy of cooling relates to high-income countries. Furthermore, there is a theoretical risk that problems such as immune suppression by hypothermia may be deleterious in a different setting; one pilot study in a low-resource setting [4] reported more deaths in the cooled group and the expensive high tech cooling devices used in the developed world are not appropriate for global use in low- and mid-resource settings.

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Type
Chapter
Information
Neonatal Neural Rescue
A Clinical Guide
 , pp. 128 - 141
Publisher: Cambridge University Press
Print publication year: 2013

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References

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